| NPI | 1275101214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417828) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN2000100) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2026-06-05 |