| NPI | 1013021039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 5563) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 151) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2020-07-29 |