NPI | 1063485654 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MA 21460) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21460) |
1223G0001X Dentist, General Practice (Licence: NH 3293) | |
1223G0001X Dentist, General Practice (Licence: MN D11553) | |
Enumeration Date | 2006-02-13 |
Last Update Date | 2007-07-08 |