| NPI | 1316953599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 5212) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 12309) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-09-02 |