| NPI | 1841308723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI 1612) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI 1612) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2025-05-28 |