NPI | 1467893636 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415518) |
Additional Taxonomies | 122300000X Dentist (Licence: NC 151030) |
Enumeration Date | 2013-07-16 |
Last Update Date | 2018-09-30 |