| NPI | 1003782756 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC DGD.11276.GD) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN124008) |
| Enumeration Date | 2025-10-10 |
| Last Update Date | 2025-11-26 |