| NPI | 1093480782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 7529) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61904) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2024-03-04 |