| NPI | 1992077200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD MD6401) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: DE G1-0001178) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2012-02-01 |