| NPI | 1740302629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 7460) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN 15694) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2025-09-03 |