| NPI | 1093100943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12998) |
| Additional Taxonomies | 125Q00000X Oral Medicinist (Licence: NC 12998) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2024-03-04 |