| NPI | 1528022613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 014868) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 6498) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2025-08-05 |