NPI | 1861692360 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 4947499-9923) |
Additional Taxonomies | 122300000X Dentist (Licence: AK 1243) |
Enumeration Date | 2007-07-23 |
Last Update Date | 2019-09-16 |