NPI | 1073765053 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 60310) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: AZ 8188) |
Enumeration Date | 2008-10-21 |
Last Update Date | 2012-05-29 |