NPI | 1609033075 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9982) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00011186) |
Enumeration Date | 2008-05-21 |
Last Update Date | 2010-05-30 |