NPI | 1356455513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN21030) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DSO16349L) |
Enumeration Date | 2006-08-17 |
Last Update Date | 2015-11-12 |