| NPI | 1952925026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13600) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 04555) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2025-08-06 |