NPI | 1356578025 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401413327) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN18250) |
Enumeration Date | 2009-06-19 |
Last Update Date | 2020-07-04 |