NPI | 1174703219 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: OR d9198) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WY 1181) |
Enumeration Date | 2007-11-06 |
Last Update Date | 2013-03-22 |