| NPI | 1174501472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 6937) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 014097) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 6927) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 014097) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2007-07-08 |