| NPI | 1922493345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12682) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10017) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2025-08-15 |