| NPI | 1225105539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 600198115) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 3229) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2025-09-20 |