NPI | 1083834576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
Additional Taxonomies | 122300000X Dentist (Licence: WI 5131) |
1223G0001X Dentist, General Practice (Licence: WI 5131) | |
Enumeration Date | 2007-04-26 |
Last Update Date | 2013-10-03 |