| NPI | 1619954203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60274) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2004014920) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2007-07-08 |