| NPI | 1659390904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 442) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 10479) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-03-07 |