NPI | 1144430901 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI 1953) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 45328) |
Enumeration Date | 2007-05-23 |
Last Update Date | 2007-07-08 |