| NPI | 1891473914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS044104) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC DGD.10552) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2025-06-05 |