| NPI | 1073287132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 12730935-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011074) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2026-03-25 |