| NPI | 1083609838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2211) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 6133) |
| 1223G0001X Dentist, General Practice (Licence: CO 105752) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2014-08-14 |