| NPI | 1700223708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61140) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9859) |
| 122300000X Dentist (Licence: MO 2015000298) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2015-04-07 |