| NPI | 1518645258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 62130) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2023020655) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2023-07-11 |