| NPI | 1225923766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: FL DTP869) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DTP869) |
| Enumeration Date | 2025-06-12 |
| Last Update Date | 2026-03-12 |