| NPI | 1114554151 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 62050) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA DDS-09884) |
| 1223G0001X Dentist, General Practice (Licence: MO 2023013035) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-05-08 |