| NPI | 1396057030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1511) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2407) |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2026-09-01 |