| NPI | 1841630787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61235) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2013016297) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2016-09-08 |