| NPI | 1477718146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1331) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9142) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2013-04-23 |