| NPI | 1902977168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-264) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21385) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2016-06-15 |