NPI | 1649290065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WI 4712015) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2177035) |
Enumeration Date | 2006-07-20 |
Last Update Date | 2007-07-08 |