| NPI | 1912289885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-55577) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 3082668-9922) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2023-08-24 |