NPI | 1386662625 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS025311L) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS025311L) |
Enumeration Date | 2006-07-17 |
Last Update Date | 2011-04-26 |