NPI | 1306993191 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 4965) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 22986) |
Enumeration Date | 2007-01-04 |
Last Update Date | 2014-02-19 |