NPI | 1235115304 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: MO 2001012903) |
Additional Taxonomies | 122300000X Dentist (Licence: MO 2001012903) |
Enumeration Date | 2005-12-20 |
Last Update Date | 2012-11-06 |