| NPI | 1982681540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60208) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2020013338) |
| Enumeration Date | 2005-12-26 |
| Last Update Date | 2025-10-03 |