| NPI | 1154079341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 10744) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NC 10744) |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2026-04-21 |