| NPI | 1821194689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME 3228) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AK 517) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-08 |