NPI | 1790740322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: HI 2192) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 52815) |
1223P0300X Dentist, Periodontics (Licence: IL 019018177) | |
Enumeration Date | 2006-04-18 |
Last Update Date | 2015-02-05 |