| NPI | 1427222405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AK unknown) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK unknown) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AK unknown) | |
| Enumeration Date | 2008-04-21 |
| Last Update Date | 2008-04-21 |