| NPI | 1518063866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV 5113) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 5113) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2026-06-30 |