| NPI | 1932898830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 62312) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 41474) |
| 1223G0001X Dentist General Practice (Licence: CA 112098) | |
| 1223G0001X Dentist General Practice (Licence: CO DEN.00206337) | |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2025-07-22 |