| NPI | 1154053445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125Q00000X Oral Medicine (Licence: NC 0295) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 0295) |
| 1223G0001X Dentist, General Practice (Licence: NC 0295) | |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2025-08-27 |