| NPI | 1013392539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6629) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 9241) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2015-07-27 |