| NPI | 1518298207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61084) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7550640-9921) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2014-08-19 |