| NPI | 1265327431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 62316) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2025019845) |
| Enumeration Date | 2025-06-10 |
| Last Update Date | 2025-06-10 |