NPI | 1265561880 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: AK 1111) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9007) |
Enumeration Date | 2007-03-02 |
Last Update Date | 2007-11-05 |