NPI | 1144374521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: IA 7484) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 7484) |
Enumeration Date | 2007-01-22 |
Last Update Date | 2007-07-09 |