| NPI | 1205536240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 42353) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: TX 42353) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2026-09-07 |