NPI | 1174742589 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410715) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401410715) |
Enumeration Date | 2007-04-24 |
Last Update Date | 2014-04-04 |