NPI | 1528198918 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MD 8490) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS024292L) |
Enumeration Date | 2007-03-06 |
Last Update Date | 2018-10-22 |