NPI | 1073619755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD MD3523) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS0203264R) |
Enumeration Date | 2006-09-16 |
Last Update Date | 2007-07-08 |