| NPI | 1033308689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5485) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 13196763-9921) |
| 1223G0001X Dentist, General Practice (Licence: CA 56025) | |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2024-09-09 |