| NPI | 1932376910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9032) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2022-11-29 |