NPI | 1174734263 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: PA DS024907L) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS 024907-L) |
Enumeration Date | 2007-05-24 |
Last Update Date | 2010-02-19 |