| NPI | 1477636165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4809) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 41219) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2023-03-07 |