NPI | 1538179528 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 9654) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 0382050) |
Enumeration Date | 2006-08-09 |
Last Update Date | 2016-12-20 |