| NPI | 1134700883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 62196) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 37149) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2023-09-25 |