NPI | 1518212661 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: VA 0401413685) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60296321) |
Enumeration Date | 2012-07-16 |
Last Update Date | 2015-08-18 |