| NPI | 1851408991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 9507) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ND 1715) |
| 1223G0001X Dentist, General Practice (Licence: WI 6001907-15) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2025-10-02 |