| NPI | 1376791251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AK 1379) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: UT 7078714-9922) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2014-12-01 |