| NPI | 1568015345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 14233693-9926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN24461) |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2025-09-17 |