| NPI | 1588878342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-124) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 6721) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 12345678) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2024-11-11 |