NPI | 1013299189 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NC 9631) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 27405) |
Enumeration Date | 2011-09-15 |
Last Update Date | 2016-06-13 |