NPI | 1801174198 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855826) |
Additional Taxonomies | 122300000X Dentist (Licence: CT 010677) |
Enumeration Date | 2011-08-03 |
Last Update Date | 2013-08-12 |