| NPI | 1689341125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN32338) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 106282) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2026-09-03 |