| NPI | 1427131531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 13052) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 5693) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-08 |