NPI | 1619237708 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WI 7117) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: WI 7117) |
122300000X Dentist (Licence: ME DEN4255) | |
Enumeration Date | 2012-05-22 |
Last Update Date | 2013-09-18 |