| NPI | 1659723898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD11379) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN22083) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC DGD11381) | |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2026-05-29 |