| NPI | 1144455585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV WV3858) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 3858) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2025-03-17 |