NPI | 1174786362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 10575) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008109) |
Enumeration Date | 2008-07-08 |
Last Update Date | 2008-07-08 |