NPI | 1164624904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MD 5285) |
Additional Taxonomies | 122300000X Dentist (Licence: MD 5285) |
Enumeration Date | 2007-06-04 |
Last Update Date | 2007-07-08 |