NPI | 1366688392 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MD 14365) |
Additional Taxonomies | 122300000X Dentist (Licence: MD 14365) |
Enumeration Date | 2008-12-22 |
Last Update Date | 2014-10-20 |