| NPI | 1417929589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 6837) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 015431) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2007-09-06 |