| NPI | 1982760153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID 2971138) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D7442) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2026-07-29 |