| NPI | 1952022055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DENT.DE.61617769) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7663) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2025-04-16 |