| NPI | 1871560649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 10375) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 9965) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2025-09-11 |