| NPI | 1285881243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-112C) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037022) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2017-03-30 |