| NPI | 1801450242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D012628) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 061150) |
| 122300000X Dentist (Licence: AZ D012628) | |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2025-09-20 |