NPI | 1598053126 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855892) |
Additional Taxonomies | 122300000X Dentist (Licence: NH 04936) |
122300000X Dentist (Licence: CT 010682) | |
122300000X Dentist (Licence: PA DS038961) | |
Enumeration Date | 2011-07-18 |
Last Update Date | 2024-01-17 |