| NPI | 1154381242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OK 76) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 5783) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2025-04-22 |