| NPI | 1669107397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 12870665-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 12870665-9921) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2026-06-30 |