| NPI | 1992498844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13688) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 13421681-9921) |
| 122300000X Dentist (Licence: UT 13421681-8903) | |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2026-09-30 |