| NPI | 1811488398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: SC DGD.10308) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 10108) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2025-12-22 |