| NPI | 1942993118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D012543) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11797) |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2025-11-06 |