| NPI | 1013389295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7137) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34787) |
| 1223G0001X Dentist, General Practice (Licence: DE G1-0001384) | |
| 1223G0001X Dentist, General Practice (Licence: NE 7268) | |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2024-01-08 |