| NPI | 1932187093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 60010) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60010) |
| 122300000X Dentist (Licence: MO 2000150743) | |
| 122300000X Dentist (Licence: VA 410236) | |
| Enumeration Date | 2006-01-08 |
| Last Update Date | 2023-10-24 |