NPI | 1720081334 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 5092) |
Additional Taxonomies | 122300000X Dentist (Licence: OR D9982) |
Enumeration Date | 2005-05-27 |
Last Update Date | 2013-12-19 |