| NPI | 1669496824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 8008) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5590-015) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2013-12-12 |