| NPI | 1467197822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 4838) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 19111) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN2000237) | |
| Enumeration Date | 2022-04-30 |
| Last Update Date | 2026-07-17 |