| NPI | 1619947868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL LNO 4138) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DE G1-00011097) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2025-09-11 |