| NPI | 1366435331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS044372) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 6814) |
| 122300000X Dentist (Licence: PA DS044372) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2025-01-31 |