| NPI | 1063741593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK OK-5530) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 5492) |
| Enumeration Date | 2009-12-11 |
| Last Update Date | 2011-12-27 |