NPI | 1528261682 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CO 9675) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 2403) |
Enumeration Date | 2007-06-07 |
Last Update Date | 2012-03-14 |