NPI | 1710262936 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE60606761) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 81213469921) |
Enumeration Date | 2011-10-19 |
Last Update Date | 2016-01-18 |