NPI | 1225198476 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MD 13645) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13645) |
1223G0001X Dentist, General Practice (Licence: PA DS-036317) | |
Enumeration Date | 2006-12-11 |
Last Update Date | 2021-11-17 |