NPI | 1629242946 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: DC DEN1000707) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MD 13704) |
Enumeration Date | 2008-04-17 |
Last Update Date | 2008-04-17 |