NPI | 1275674004 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 343166-9922) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 144504-9922) |
Enumeration Date | 2007-02-12 |
Last Update Date | 2007-07-08 |