| NPI | 1689126724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2016019198) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6845) |
| 1223G0001X Dentist, General Practice (Licence: KS 61488) | |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2019-08-20 |