| NPI | 1538357769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1229) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 1092) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2007-10-12 |