NPI | 1962835553 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AL 5928) |
Additional Taxonomies | 122300000X Dentist (Licence: AL 5928) |
126900000X Dental Laboratory Technician (Licence: AL 233720-00) | |
Enumeration Date | 2013-08-19 |
Last Update Date | 2015-02-11 |