| NPI | 1962563320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60593) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 7205) |
| 1223G0001X Dentist, General Practice (Licence: CO 7205) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2019-04-02 |