| NPI | 1386605558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA DDS-10176) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 4890) |
| 1223G0001X Dentist, General Practice (Licence: NE 4890) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2026-09-28 |