| NPI | 1003536269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2026013015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1859908) |
| 122300000X Dentist (Licence: IL 019.033762) | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2026-06-19 |