| NPI | 1326066721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1413) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-3972) |
| 1223G0001X Dentist, General Practice (Licence: TX 25932) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-02-10 |