NPI | 1184851354 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MA dn1855260) |
Additional Taxonomies | 122300000X Dentist (Licence: RI den03099) |
Enumeration Date | 2009-06-16 |
Last Update Date | 2011-09-28 |