| NPI | 1609939354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 5819) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 011369) |
| 1223G0001X Dentist, General Practice (Licence: FL DN6131) | |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2007-07-08 |