| NPI | 1720137011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 62091) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D3838) |
| 1223G0001X Dentist, General Practice (Licence: ID D-3838) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2024-05-16 |