| NPI | 1679533988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 27752) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60279) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2007-10-10 |