| NPI | 1699942086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 2039) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 1223G0001x-2039) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2008-05-14 |