NPI | 1669532420 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 60299) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2004013594) |
Enumeration Date | 2006-12-11 |
Last Update Date | 2019-04-23 |