NPI | 1730269069 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MN 8276) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WI 5002088-015) |
Enumeration Date | 2006-10-17 |
Last Update Date | 2007-07-08 |