NPI | 1063500643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5499) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53662) |
1223G0001X Dentist, General Practice (Licence: KY 8294) | |
Enumeration Date | 2006-10-10 |
Last Update Date | 2017-06-01 |