NPI | 1134729767 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61771) |
Additional Taxonomies | 122300000X Dentist (Licence: KS 61771) |
1223G0001X Dentist, General Practice (Licence: MO 2020032973) | |
Enumeration Date | 2020-11-01 |
Last Update Date | 2023-05-28 |