| NPI | 1740353390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 08076) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI WI3652) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2025-11-02 |