| NPI | 1568395622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 14290135-9926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 14290135-8903) |
| Enumeration Date | 2026-06-06 |
| Last Update Date | 2026-06-06 |