NPI | 1518140078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE00007254) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 50860) |
122300000X Dentist (Licence: OR D9396) | |
Enumeration Date | 2007-12-06 |
Last Update Date | 2011-06-27 |