| NPI | 1851784417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN22267) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 3186) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2026-02-02 |