NPI | 1477710606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: ND ND1592) |
Additional Taxonomies | 122300000X Dentist (Licence: AZ D2647) |
122300000X Dentist (Licence: OR D5778) | |
Enumeration Date | 2008-05-16 |
Last Update Date | 2008-05-16 |