| NPI | 1144619057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61083) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 9039485-9922) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2016-06-08 |