| NPI | 1205863941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4775) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 341592992) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2015-01-21 |