| NPI | 1679386288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI DEN03802) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901602308) |
| Enumeration Date | 2025-01-28 |
| Last Update Date | 2026-01-15 |