| NPI | 1689631962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN15716) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 112884) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2026-05-12 |