| NPI | 1811366214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61316) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 31437) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2025-05-14 |