NPI | 1497023196 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OK 72) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020564) |
Enumeration Date | 2011-12-08 |
Last Update Date | 2023-12-14 |