| NPI | 1417873688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 14281358-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 14281358-8903) |
| Enumeration Date | 2026-06-24 |
| Last Update Date | 2026-06-24 |