NPI | 1558420455 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 25414) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00010624) |
Enumeration Date | 2006-12-06 |
Last Update Date | 2017-07-06 |