| NPI | 1285759183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 7745) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 14153) |
| 122300000X Dentist (Licence: AZ D011289) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2025-08-01 |