| NPI | 1891687786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 14224686-9926) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2025-07-16 |
| Last Update Date | 2025-07-16 |