NPI | 1467664128 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 9079) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 4841) |
1223G0001X Dentist, General Practice (Licence: NC 4595) | |
Enumeration Date | 2007-05-04 |
Last Update Date | 2007-07-08 |