NPI | 1578638227 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 10550) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401006441) |
Enumeration Date | 2006-11-21 |
Last Update Date | 2007-07-08 |