| NPI | 1396715066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D7493) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D3873) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-03-07 |