NPI | 1740266170 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WI 6021-015) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IA 07983) |
Enumeration Date | 2005-12-18 |
Last Update Date | 2007-07-08 |