| NPI | 1184725509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60425) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2008028175) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2009-04-20 |