| NPI | 1548014210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 13909845-9923) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 62270) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2025-04-24 |