NPI | 1699184648 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 10006) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 9054856-9921) |
1223P0300X Dentist, Periodontics (Licence: UT 90548569921) | |
Enumeration Date | 2014-08-04 |
Last Update Date | 2022-01-11 |