NPI | 1245348960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MS 2882-95) |
Additional Taxonomies | 122300000X Dentist (Licence: AL 5389 C) |
1223P0300X Dentist, Periodontics (Licence: MS PER-323-98) | |
1223P0300X Dentist, Periodontics (Licence: AL 5389 C) | |
Enumeration Date | 2006-08-25 |
Last Update Date | 2007-07-08 |