NPI | 1578090395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401417686) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: DC DEN2000045) |
1223P0300X Dentist, Periodontics (Licence: MD 17409) | |
Enumeration Date | 2017-05-11 |
Last Update Date | 2022-11-19 |