| NPI | 1609555804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 04019189) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 1346146-9921) |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2025-10-28 |