NPI | 1316351851 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415130) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN20689) |
Enumeration Date | 2014-06-12 |
Last Update Date | 2016-04-07 |