| NPI | 1720214752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61284) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2009013183) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2016-11-27 |