| NPI | 1891206421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 14153) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1857766) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2025-11-21 |