| NPI | 1962668897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13164) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: NC 13164) |
| 122300000X Dentist (Licence: GA DN013703) | |
| 122300000X Dentist (Licence: NC 13164) | |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2025-10-09 |