| NPI | 1326197385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AL D0006716C) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 2025-83) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2022-06-06 |