NPI | 1225293368 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME DEN4069) |
Additional Taxonomies | 122300000X Dentist (Licence: AZ D7613) |
Enumeration Date | 2008-07-28 |
Last Update Date | 2017-02-15 |