| NPI | 1659508968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 9560) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2009013242) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2025-12-01 |