NPI | 1225040116 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5765733-9922) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8256) |
Enumeration Date | 2006-08-12 |
Last Update Date | 2012-09-07 |