NPI | 1518983402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MI 2901011027) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019025116) |
122300000X Dentist (Licence: WA DE00008643) | |
Enumeration Date | 2006-07-14 |
Last Update Date | 2007-07-08 |