NPI | 1073771580 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MO 2022012734) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KS 61988) |
Enumeration Date | 2008-05-30 |
Last Update Date | 2022-04-28 |