| NPI | 1609979913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 8299) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 7019) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2025-09-12 |