NPI | 1104833730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: OK 5900) |
Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OK 62) |
Enumeration Date | 2006-08-03 |
Last Update Date | 2015-05-15 |