| NPI | 1417067349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 7124) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 18482) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2025-10-24 |