| NPI | 1891539326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123963) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 13944804-9926) |
| Enumeration Date | 2024-06-20 |
| Last Update Date | 2025-10-13 |