| NPI | 1427074020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2008008592) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60310) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2022-01-05 |