NPI | 1245470913 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NV 5952) |
Additional Taxonomies | 122300000X Dentist (Licence: AZ D7720) |
1223G0001X Dentist, General Practice (Licence: CA 58289) | |
Enumeration Date | 2009-02-20 |
Last Update Date | 2016-02-29 |