NPI | 1902990401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: KY 5561) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KY 567) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 568) | |
Enumeration Date | 2006-10-02 |
Last Update Date | 2007-07-08 |