NPI | 1093803645 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 18000) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 18000) |
Enumeration Date | 2006-10-10 |
Last Update Date | 2007-07-09 |