NPI | 1043332844 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA 0700009204) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA 0700009204) |
Enumeration Date | 2007-04-04 |
Last Update Date | 2007-07-08 |