NPI | 1568496016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN14193) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN14193) |
Enumeration Date | 2006-07-10 |
Last Update Date | 2018-10-29 |