NPI | 1063539138 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MS 180178) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 180178) |
Enumeration Date | 2007-03-23 |
Last Update Date | 2007-12-17 |