| NPI | 1902808082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN31185) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 7148) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2026-01-27 |