NPI | 1275912115 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VT 016.0111405) |
Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0111405) |
Enumeration Date | 2015-05-26 |
Last Update Date | 2015-06-08 |