| NPI | 1932071701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 62438) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2025038329) |
| Enumeration Date | 2025-09-22 |
| Last Update Date | 2025-09-22 |