| NPI | 1477623270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC24138) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D5674) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2025-08-26 |