NPI | 1083876775 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10536) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D4160) |
Enumeration Date | 2008-06-25 |
Last Update Date | 2011-09-14 |