| NPI | 1205854627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4993T) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 4116) |
| 1223G0001X Dentist, General Practice (Licence: VA 3504) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |