| NPI | 1275795684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60566) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6053) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2011-03-14 |