NPI | 1689894743 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 11905) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13447) |
Enumeration Date | 2007-04-30 |
Last Update Date | 2007-07-08 |