NPI | 1538249321 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE00009560) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE00009560) |
Enumeration Date | 2006-10-16 |
Last Update Date | 2015-06-02 |