| NPI | 1982010229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61150) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 30025) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-02-09 |