| NPI | 1881767200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 9846) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 9846) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2025-10-10 |