| NPI | 1902595317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 8158) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 62114) |
| 1223G0001X Dentist, General Practice (Licence: MO 2023020439) | |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2026-09-15 |