| NPI | 1326153156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 036006) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 043797) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2025-09-11 |