| NPI | 1821172594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI 1790) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 35002) |
| 1223G0001X Dentist, General Practice (Licence: MD 9681) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2026-04-13 |