| NPI | 1679143028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61971) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7739) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2026-06-30 |