NPI | 1154861227 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 9001) |
Additional Taxonomies | 122300000X Dentist (Licence: SC 9001) |
Enumeration Date | 2017-03-08 |
Last Update Date | 2024-09-03 |