| NPI | 1669430443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4173) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS023860L) |
| 1223G0001X Dentist, General Practice (Licence: SD M858) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2007-07-10 |