NPI | 1346285525 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401415395) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS036823) |
1223P0300X Dentist, Periodontics (Licence: NC 9303) | |
1223P0300X Dentist, Periodontics (Licence: TX 25309) | |
Enumeration Date | 2006-06-19 |
Last Update Date | 2024-07-17 |