| NPI | 1700362886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4971) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4971) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2025-06-23 |