| NPI | 1679582761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN30877) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 4847) |
| Enumeration Date | 2006-08-06 |
| Last Update Date | 2026-07-01 |