| NPI | 1952494734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60465) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD2800) |
| 1223G0001X Dentist, General Practice (Licence: TX 23553) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2015-03-26 |