NPI | 1134199003 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MD 9520) |
Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MD 9520) |
Enumeration Date | 2006-01-24 |
Last Update Date | 2018-07-12 |