NPI | 1730273913 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 5587) |
Additional Taxonomies | 122300000X Dentist (Licence: KY 5587) |
Enumeration Date | 2006-10-03 |
Last Update Date | 2015-01-20 |