NPI | 1417044686 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 5646) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 7534) |
Enumeration Date | 2006-10-06 |
Last Update Date | 2016-01-28 |