| NPI | 1316141583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 10038) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60479) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2022-06-17 |