| NPI | 1992119184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 9052001-9926) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D010255) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2025-08-21 |