NPI | 1013082833 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 4537) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 2841) |
Enumeration Date | 2006-11-21 |
Last Update Date | 2014-12-04 |