| NPI | 1023268430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 0304) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: IA 40108) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2025-11-20 |