| NPI | 1730556515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID d4664) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7888) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2024-08-21 |