NPI | 1194882001 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410829) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 56152) |
Enumeration Date | 2007-01-02 |
Last Update Date | 2013-03-04 |