| NPI | 1245756675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 61552) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: LA 6815) |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2019-08-27 |