| NPI | 1952410656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8907) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN122966) |
| 122300000X Dentist (Licence: AL D-0007103-C) | |
| 1223G0001X Dentist, General Practice (Licence: KY 9421) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2026-06-05 |