| NPI | 1124689112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61934) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2019021954) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2021-08-17 |