| NPI | 1669496816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 10163) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 10629) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2025-02-11 |