| NPI | 1003594326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: NC 14518) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 14518) |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2025-12-08 |