| NPI | 1437193075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4965) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 973448669922) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-04-12 |