| NPI | 1982755898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5534) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 5709) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2023-04-10 |