NPI | 1235341991 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 9411) |
Additional Taxonomies | 122300000X Dentist (Licence: MD 6539) |
122300000X Dentist (Licence: KY 9411) | |
Enumeration Date | 2007-05-04 |
Last Update Date | 2015-01-20 |