| NPI | 1770641045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D7663) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4057) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2018-12-11 |