| NPI | 1780868455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2009013643) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60531) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2021-01-11 |