NPI | 1003015603 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901019560) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019560) |
Enumeration Date | 2007-07-13 |
Last Update Date | 2007-07-13 |