| NPI | 1962668897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013703) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 13164) |
| 1223D0001X Dentist, Dental Public Health (Licence: NC 13164) | |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2026-06-23 |