NPI | 1205863941 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4775) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 341592992) |
Enumeration Date | 2006-06-27 |
Last Update Date | 2015-01-21 |