| NPI | 1710307392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV S7-92) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6767) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2016-08-07 |