| NPI | 1942839766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61701) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN016014.) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2020-08-19 |