| NPI | 1285612705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4192) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN18779) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2023-10-06 |