NPI | 1235211129 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO654) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 4622) |
Enumeration Date | 2006-10-19 |
Last Update Date | 2011-08-24 |