NPI | 1871945840 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MD 16140) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415271) |
Enumeration Date | 2016-07-01 |
Last Update Date | 2019-12-18 |