| NPI | 1326244757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5894) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411814) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2010-04-05 |