| NPI | 1689768343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2016009926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 5658) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2018-11-27 |