NPI | 1578786794 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN16276) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NC 10536) |
Enumeration Date | 2007-04-10 |
Last Update Date | 2018-05-02 |