NPI | 1962548297 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: SC 4276) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 47828) |
122300000X Dentist (Licence: AZ 6137) | |
Enumeration Date | 2007-01-30 |
Last Update Date | 2012-12-05 |