| NPI | 1710921135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2030-83) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 2030-83) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2026-10-12 |