| NPI | 1689036303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4858) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10666) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2025-01-03 |