| NPI | 1295768430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2000165880) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60241) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2007-07-09 |