NPI | 1649591918 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 15446) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038337) |
Enumeration Date | 2010-06-21 |
Last Update Date | 2019-07-04 |