| NPI | 1427891936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 62171) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 4759) |
| Enumeration Date | 2024-06-13 |
| Last Update Date | 2025-05-30 |