NPI | 1619195054 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS021779L) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS021779L) |
Enumeration Date | 2007-04-23 |
Last Update Date | 2007-07-08 |