| NPI | 1043008204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 8236) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DENT.DE.70135737) |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2026-09-15 |