NPI | 1902217490 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401415627) |
Additional Taxonomies | 122300000X Dentist (Licence: KY 9415) |
Enumeration Date | 2014-05-19 |
Last Update Date | 2020-10-24 |