| NPI | 1669532420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 60299) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2004013594) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2019-04-23 |