NPI | 1275603482 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4549) |
Additional Taxonomies | 122300000X Dentist (Licence: WA 60386595) |
Enumeration Date | 2006-11-08 |
Last Update Date | 2013-10-01 |