NPI | 1538422662 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: SC 8587) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS039125) |
Enumeration Date | 2012-06-22 |
Last Update Date | 2016-10-20 |