NPI | 1275785545 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN19153) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401411932) |
Enumeration Date | 2008-10-17 |
Last Update Date | 2010-08-06 |