| NPI | 1194194506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 7470) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856730) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2021-10-13 |