| NPI | 1306143847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV NV6813) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08790) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2016-11-14 |