NPI | 1629214820 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ D7990) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 57242) |
Enumeration Date | 2008-12-18 |
Last Update Date | 2016-06-29 |