| NPI | 1346266541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10736) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 1977) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2022-10-21 |