NPI | 1588863427 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 17642) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54657) |
Enumeration Date | 2007-07-11 |
Last Update Date | 2009-12-22 |