| NPI | 1730590936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KS 61425) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KY 9361) |
| Enumeration Date | 2014-05-11 |
| Last Update Date | 2026-06-24 |