| NPI | 1083604599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 323334-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60068) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2022-12-11 |