NPI | 1356326029 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 12387) |
Additional Taxonomies | 122300000X Dentist (Licence: NM DD2591) |
Enumeration Date | 2005-12-14 |
Last Update Date | 2008-07-23 |