| NPI | 1538713342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5582) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7261) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2024-09-17 |