| NPI | 1427097161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401006818) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN4546) |
| 1223G0001X Dentist, General Practice (Licence: MD 8462) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |