| NPI | 1053406058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-3747) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D8591) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2015-05-12 |