| NPI | 1932895240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC DGD.11415) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.10722) |
| 122300000X Dentist (Licence: WI 6001411-15) | |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2026-07-13 |