| NPI | 1306639422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401419472) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401419472) |
| Enumeration Date | 2025-05-22 |
| Last Update Date | 2025-07-21 |