NPI | 1295925675 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5255056-9922) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5255056-8903) |
Enumeration Date | 2007-07-31 |
Last Update Date | 2007-07-31 |