| NPI | 1427022854 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KS 6098) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 6098) |
| 122300000X Dentist (Licence: MO 015647) | |
| 1223P0300X Dentist, Periodontics (Licence: MO 015647) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2012-06-22 |