NPI | 1619176682 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN5400) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN5400) |
Enumeration Date | 2007-07-11 |
Last Update Date | 2007-07-11 |