NPI | 1508039660 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN17899) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CO DEN-9692) |
Enumeration Date | 2008-04-10 |
Last Update Date | 2015-05-28 |