| NPI | 1023620523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61717) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2020026451) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2025-09-26 |