| NPI | 1053723700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 13770532-9926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN20801) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2026-05-27 |