| NPI | 1952592032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123752) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008863) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2025-06-24 |