| NPI | 1679671713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 13649) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 112487) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2025-11-25 |