NPI | 1740391465 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NV S4-113C) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN4783) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2023-04-10 |