| NPI | 1689739641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 9646) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 5518) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2026-08-20 |