| NPI | 1447255955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AK 1274) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: UT 139712-9922) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2012-09-10 |