NPI | 1417169715 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 11937) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008267) |
Enumeration Date | 2007-05-07 |
Last Update Date | 2007-07-08 |