NPI | 1932580719 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 011506) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MA DN1856864) |
Enumeration Date | 2015-06-17 |
Last Update Date | 2015-10-20 |