NPI | 1871880666 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 9717) |
Additional Taxonomies | 122300000X Dentist (Licence: KY 9717) |
Enumeration Date | 2011-06-30 |
Last Update Date | 2023-03-06 |