| NPI | 1013657576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DTP877) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 38228) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2026-05-20 |