| NPI | 1194458828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 24139) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401417988) |
| Enumeration Date | 2022-07-09 |
| Last Update Date | 2026-02-18 |