NPI | 1356493795 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10687) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 21506) |
Enumeration Date | 2007-01-17 |
Last Update Date | 2012-10-08 |