NPI | 1396855466 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PR 972) |
Additional Taxonomies | 122300000X Dentist (Licence: PR 972) |
Enumeration Date | 2006-08-30 |
Last Update Date | 2016-01-20 |