| NPI | 1689892580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 015901) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60842) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2018-03-17 |