| NPI | 1356408173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2024006686) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 51649) |
| 1223G0001X Dentist, General Practice (Licence: AR 4564) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2025-10-07 |