| NPI | 1841454683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D07562) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D7562) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2026-02-17 |