NPI | 1619131497 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: KY 6182) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 6182) |
Enumeration Date | 2008-07-11 |
Last Update Date | 2008-07-11 |