| NPI | 1427626779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-5280) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OK 7998) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2025-05-13 |