NPI | 1477846632 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AL 6169) |
Additional Taxonomies | 122300000X Dentist (Licence: NC 9111) |
Enumeration Date | 2011-05-20 |
Last Update Date | 2024-11-07 |