NPI | 1174506745 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL 480) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401008175) |
Enumeration Date | 2005-11-28 |
Last Update Date | 2007-12-12 |