| NPI | 1801778220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA na) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA na) |
| Enumeration Date | 2025-07-24 |
| Last Update Date | 2025-08-14 |