| NPI | 1649438169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 6498) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 3941) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2015-01-09 |