NPI | 1659509453 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 14644) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412823) |
Enumeration Date | 2009-06-30 |
Last Update Date | 2016-03-18 |