NPI | 1609242411 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 108114) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IN 12012407A) |
Enumeration Date | 2015-08-16 |
Last Update Date | 2022-09-23 |