| NPI | 1346839123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 241) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 7044) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: OK 241) | |
| Enumeration Date | 2021-01-15 |
| Last Update Date | 2021-03-09 |