| NPI | 1740407501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 015230) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KS KS6683) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2009-11-13 |