| NPI | 1083584320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ DO12393) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D012393) |
| Enumeration Date | 2025-11-11 |
| Last Update Date | 2026-02-17 |