| NPI | 1841587250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: KS 61283) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2011014424) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2022-12-12 |