| NPI | 1295897114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011796) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2102) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2026-10-02 |