NPI | 1366611014 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 28720) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE00010989) |
Enumeration Date | 2008-02-27 |
Last Update Date | 2018-11-14 |