NPI | 1114068905 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401412502) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55071) |
Enumeration Date | 2007-02-12 |
Last Update Date | 2016-02-20 |