NPI | 1184770448 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D8524) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 24519) |
Enumeration Date | 2007-01-26 |
Last Update Date | 2014-01-15 |