| NPI | 1477600666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6231) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7110) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2014-02-20 |