| NPI | 1629591540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT DEN-DEN-LIC-30767) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DENT.DE.70135755) |
| 122300000X Dentist (Licence: SC 10421) | |
| Enumeration Date | 2017-07-23 |
| Last Update Date | 2026-07-02 |