NPI | 1326181355 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13413) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN1000368) |
1223G0001X Dentist, General Practice (Licence: VA 0401410968) | |
Enumeration Date | 2007-02-15 |
Last Update Date | 2018-03-17 |