| NPI | 1447356209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60524) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 015596) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2018-04-30 |