| NPI | 1275897332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 7042) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2016031541) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.029595) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2018-07-30 |