NPI | 1255575502 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: OK 6231) |
Additional Taxonomies | 122300000X Dentist (Licence: OK 6231) |
122300000X Dentist (Licence: CA 58243) | |
122300000X Dentist (Licence: KS 60643) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2009-04-29 |
Last Update Date | 2015-04-02 |