| NPI | 1841189008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 2919) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN30832) |
| Enumeration Date | 2025-07-01 |
| Last Update Date | 2025-07-24 |