NPI | 1700223708 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: KS 61140) |
Additional Taxonomies | 122300000X Dentist (Licence: OR D9859) |
122300000X Dentist (Licence: MO 2015000298) | |
Enumeration Date | 2013-05-30 |
Last Update Date | 2015-04-07 |