| NPI | 1275634396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2067) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2009007429) |
| 122300000X Dentist (Licence: IL 019.028099) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2010-02-18 |