NPI | 1710035886 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN17571) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: AL 5495) |
Enumeration Date | 2007-01-08 |
Last Update Date | 2011-12-22 |