NPI | 1952773590 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 33843) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA DL12622) |
Enumeration Date | 2015-10-22 |
Last Update Date | 2023-03-07 |