| NPI | 1245558899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NV 6251) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 59204) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2016-04-26 |