NPI | 1154545630 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: KY 5464) |
Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: KY 453) |
Enumeration Date | 2007-04-13 |
Last Update Date | 2023-03-07 |