| NPI | 1427575307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 33671) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6943) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2024-12-10 |