| NPI | 1750723706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 61402) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61042) |
| 1223D0001X Dentist Dental Public Health (Licence: KS 61042) | |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2025-03-21 |