| NPI | 1235147778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5594) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 37417) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2026-04-20 |