| NPI | 1093602385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D012773) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9336175-9926) |
| 183500000X Pharmacist (Licence: UT 9336175-1701) | |
| Enumeration Date | 2025-06-19 |
| Last Update Date | 2026-07-08 |