NPI | 1730590936 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 9361) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KS 61425) |
Enumeration Date | 2014-05-11 |
Last Update Date | 2024-08-22 |