NPI | 1396008132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: IA DDS-09259) |
Additional Taxonomies | 122300000X Dentist (Licence: MO 2012018222) |
Enumeration Date | 2012-06-18 |
Last Update Date | 2016-01-04 |