NPI | 1124689112 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61934) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2019021954) |
Enumeration Date | 2019-06-21 |
Last Update Date | 2021-08-17 |