NPI | 1417097957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 5604) |
Additional Taxonomies | 122300000X Dentist (Licence: KY 5604) |
Enumeration Date | 2007-02-07 |
Last Update Date | 2007-08-15 |