| NPI | 1154364305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: AZ 6899) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD2687) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2026-04-21 |