| NPI | 1477678357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN17798) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KS 60438) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2009-03-25 |