| NPI | 1215052246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8347) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 040100-6604) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2026-06-12 |