NPI | 1285947036 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN 20774) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 7712229-9921) |
Enumeration Date | 2010-07-22 |
Last Update Date | 2014-07-31 |