| NPI | 1114230125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 8594) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AK DEN D 1347) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2020-01-25 |