| NPI | 1811128200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60803) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2009013222) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2018-03-17 |