NPI | 1346269743 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2013000825) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12010105) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2016-01-12 |