NPI | 1679701288 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8896) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 5993) |
Enumeration Date | 2009-06-23 |
Last Update Date | 2011-12-03 |