NPI | 1477620714 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD M-618) |
Additional Taxonomies | 122300000X Dentist (Licence: NE 5118) |
Enumeration Date | 2006-11-30 |
Last Update Date | 2016-03-16 |