NPI | 1518298207 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61084) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7550640-9921) |
Enumeration Date | 2010-01-20 |
Last Update Date | 2014-08-19 |