NPI | 1306924576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: RI DEN02752) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA 20778) |
Enumeration Date | 2006-11-02 |
Last Update Date | 2007-07-08 |