| NPI | 1639516776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60828) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2011014452) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2019-09-09 |