NPI | 1417064437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401411550) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 28850) |
Enumeration Date | 2006-08-24 |
Last Update Date | 2024-07-12 |