| NPI | 1932895240 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 122300000X Dentist (Licence: SC DGD.10722) | 
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6001411-15) | 
| Enumeration Date | 2023-04-11 | 
| Last Update Date | 2025-08-28 |