| NPI | 1609216720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6478) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 202005) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2023-07-10 |