| NPI | 1932205416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KS 5509) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 5195) |
| 1223P0300X Dentist, Periodontics (Licence: WI 2640) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2007-07-16 |