NPI | 1710010012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CO 9264) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9264) |
Enumeration Date | 2007-03-14 |
Last Update Date | 2016-08-31 |