| NPI | 1992481170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 14638) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 28014) |
| 122300000X Dentist (Licence: FL DN28014) | |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2026-06-02 |