| NPI | 1730231408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 6984) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: KS 5447) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2012-10-12 |