NPI | 1609250752 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401414958) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414958) |
Enumeration Date | 2015-07-17 |
Last Update Date | 2022-08-08 |