NPI | 1134316144 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: DE g1-0001261) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 051281) |
1223P0300X Dentist, Periodontics (Licence: PA ds037447) | |
Enumeration Date | 2007-10-03 |
Last Update Date | 2009-02-23 |