| NPI | 1508870684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 143758-9926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AK 670) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2025-01-09 |