| NPI | 1275003139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN26445) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2018043097) |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2025-11-09 |