| NPI | 1598731739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60237) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 013812) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2024-05-11 |