| NPI | 1730116351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6145) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-3956) |
| 1223G0001X Dentist, General Practice (Licence: AK 1260) | |
| 1223G0001X Dentist, General Practice (Licence: UT 6313641-9922) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2011-08-08 |