| NPI | 1588098917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10431) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AK 1510) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2026-03-25 |