| NPI | 1821095712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4962) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8324) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2025-02-10 |