NPI | 1093880288 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: GA Dn013673) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 7427) |
Enumeration Date | 2006-11-22 |
Last Update Date | 2011-07-01 |