| NPI | 1023992153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401419603) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 112161) |
| Enumeration Date | 2025-08-01 |
| Last Update Date | 2025-08-01 |