NPI | 1134476674 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10734) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039288) |
Enumeration Date | 2012-08-14 |
Last Update Date | 2018-03-17 |