NPI | 1083662415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: SC SC4010) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 4010) |
Enumeration Date | 2006-05-05 |
Last Update Date | 2011-02-16 |