| NPI | 1558035576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11464) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D012397) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2025-11-20 |