| NPI | 1437599115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CT 12793) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60364057) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2025-12-31 |