| NPI | 1972553246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AK 1180) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AK 1180) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2011-10-07 |