| NPI | 1396223954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10890) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 39307) |
| Enumeration Date | 2018-08-04 |
| Last Update Date | 2026-07-23 |