| NPI | 1043457799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9218) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4977) |
| Enumeration Date | 2009-01-17 |
| Last Update Date | 2018-11-06 |