| NPI | 1154863223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10527) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 10527) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2025-01-22 |