| NPI | 1780385369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC DGD.11217.GD) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: SC DGD.11221.DS) |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2026-01-07 |