NPI | 1770783094 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: KS 60610) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2006024257) |
Enumeration Date | 2007-07-24 |
Last Update Date | 2009-01-07 |