| NPI | 1841925757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN31647) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH29950) |
| Enumeration Date | 2022-07-24 |
| Last Update Date | 2026-05-22 |