| NPI | 1881900066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NV 6612) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2010030120) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2022-02-01 |