NPI | 1417067182 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0438000149) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000149) |
Enumeration Date | 2006-08-30 |
Last Update Date | 2007-07-08 |