| NPI | 1619942083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 7117) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19850) |
| 122300000X Dentist (Licence: MO 2016000952) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2020-07-09 |