| NPI | 1003266966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61219) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2016018480) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2016-08-07 |