| NPI | 1457468183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 3032) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60352) |
| 1223G0001X Dentist, General Practice (Licence: NV S6-46C) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-09 |