| NPI | 1871666289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4961T) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00007047) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |