NPI | 1205182003 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: ID D-4649) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60289676) |
Enumeration Date | 2012-07-30 |
Last Update Date | 2015-09-21 |