| NPI | 1477512598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 60881) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE00009581) |
| 1223G0001X Dentist General Practice (Licence: MO 2007033356) | |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2018-03-17 |