NPI | 1366702532 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 83244199922) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 83244199922) |
Enumeration Date | 2012-05-22 |
Last Update Date | 2012-05-22 |