NPI | 1508946658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN013592) |
Additional Taxonomies | 122300000X Dentist (Licence: MO 2002005473) |
Enumeration Date | 2006-10-16 |
Last Update Date | 2012-08-10 |