NPI | 1033251426 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: SC 2029) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: SC 2029) |
Enumeration Date | 2007-02-13 |
Last Update Date | 2012-03-16 |