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 |