| NPI | 1295706026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 036137) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2015-08-07 |