| NPI | 1073737490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1082) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 23182) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2019-01-09 |