| NPI | 1811102338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 39422) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL dn17482) |
| 122300000X Dentist (Licence: FL DN17482) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: OH 30.024978) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2026-02-11 |