| NPI | 1891007225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DB-2026-0084) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 00201972) |
| 1223D0001X Dentist, Dental Public Health (Licence: WA DE61574138) | |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2026-06-19 |