NPI | 1124122429 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS014996L) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN9929) |
Enumeration Date | 2006-09-08 |
Last Update Date | 2007-07-08 |