NPI | 1689892580 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 015901) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60842) |
Enumeration Date | 2007-04-23 |
Last Update Date | 2018-03-17 |