| NPI | 1952599797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60597) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 56407) |
| 1223G0001X Dentist, General Practice (Licence: MO 2007021061) | |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2024-02-13 |