NPI | 1255350369 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 3515) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3268-03) |
1223P0221X Dentist, Pediatric Dentistry (Licence: LA PEDO3703) | |
Enumeration Date | 2006-07-19 |
Last Update Date | 2013-07-16 |