| NPI | 1942365036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AL 4402) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 0004402) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2025-07-08 |