NPI | 1285180638 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415368) |
Additional Taxonomies | 122300000X Dentist (Licence: DC DEN10001656) |
Enumeration Date | 2016-08-26 |
Last Update Date | 2022-07-22 |