| NPI | 1235268673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MT 2233) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 5404-015) |
| 1223G0001X Dentist General Practice (Licence: AK 1096) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2007-07-08 |