NPI | 1285811828 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 59158) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 21763) |
Enumeration Date | 2008-01-25 |
Last Update Date | 2013-08-30 |