| NPI | 1669165155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 8159) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 39418) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2025-07-14 |