NPI | 1568600328 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5998) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9828) |
Enumeration Date | 2009-01-30 |
Last Update Date | 2014-03-29 |