| NPI | 1063253334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: WI 6001715-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6001715) |
| 1223G0001X Dentist, General Practice (Licence: KY 10986) | |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2025-08-18 |