| NPI | 1568600328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5998) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9828) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2014-03-29 |