| NPI | 1952618555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123804) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 28702) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2026-09-08 |