NPI | 1225118508 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5625) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D11783) |
Enumeration Date | 2006-10-17 |
Last Update Date | 2007-07-09 |