NPI | 1053761072 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KS 61221) |
Additional Taxonomies | 122300000X Dentist (Licence: KS 61221) |
Enumeration Date | 2016-06-21 |
Last Update Date | 2020-04-14 |