| NPI | 1356556542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 61105) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2003014152) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2022-05-06 |