| NPI | 1689961856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60914) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2011017417) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2018-09-13 |