| NPI | 1295571032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN2001571) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401419600) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2025-10-06 |