| NPI | 1093153058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009145) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: AZ D008740) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2025-05-13 |