| NPI | 1134805583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 62111) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2023021848) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2024-06-05 |