| NPI | 1215662788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61967) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 12891810-9922) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2023-02-03 |