| NPI | 1710415245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6001152-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61368) |
| Enumeration Date | 2017-05-29 |
| Last Update Date | 2023-09-06 |