| NPI | 1134265507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV S2-12) |
| Additional Taxonomies | 209800000X Legal Medicine (Licence: NV S2-12) |
| 1223D0004X Dentist Dentist Anesthesiologist (Licence: NV S2-12) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2013-05-17 |