| NPI | 1528210853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9936) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 10839) |
| 1223P0700X Dentist, Prosthodontics (Licence: MA 10456) | |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2025-12-17 |