| NPI | 1013766815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6001842-15) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 6001842-15) |
| 1223E0200X Dentist, Endodontics (Licence: WI 6001842-15) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 6001842-15) | |
| Enumeration Date | 2024-05-14 |
| Last Update Date | 2025-11-11 |