NPI | 1194098723 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD4166) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020710) |
Enumeration Date | 2012-02-13 |
Last Update Date | 2014-09-05 |