NPI | 1326237173 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: DC DC 3734) |
Additional Taxonomies | 104100000X Social Worker (Licence: MD LC300618) |
Enumeration Date | 2007-10-17 |
Last Update Date | 2016-01-19 |