| NPI | 1144838590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: KS 61655) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61655) |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2023-09-05 |