NPI | 1558541458 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE60069344) |
Additional Taxonomies | 122300000X Dentist (Licence: AZ 7390) |
122300000X Dentist (Licence: OR D9779) | |
Enumeration Date | 2007-11-07 |
Last Update Date | 2013-08-13 |