| NPI | 1376876300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6330) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7712480-9923) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2018-12-04 |