| NPI | 1528024601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 6130) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: KS 6130) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2007-07-08 |