NPI | 1114031838 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17605) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052823-1) |
Enumeration Date | 2006-08-19 |
Last Update Date | 2007-07-08 |