| NPI | 1932201688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9395) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 9395) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2025-03-20 |