| NPI | 1134612302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11675) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN23470) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2026-06-06 |