NPI | 1235360611 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24925) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 58539) |
Enumeration Date | 2009-08-03 |
Last Update Date | 2010-10-13 |