| NPI | 1952089609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN124310) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN28351) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2026-08-11 |