NPI | 1255305116 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 105811) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: AK 1071) |
Enumeration Date | 2006-02-15 |
Last Update Date | 2012-06-12 |