NPI | 1700871118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: IN 12013438A) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601003571) |
363A00000X Physician Assistant (Licence: MI 5601003571) | |
Enumeration Date | 2005-09-13 |
Last Update Date | 2020-07-22 |