| NPI | 1730172248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 7022-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60198) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.029319) | |
| 1223G0001X Dentist, General Practice (Licence: CA 59289) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2013-04-11 |