NPI | 1720197031 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 148272) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN008044) |
Enumeration Date | 2006-08-30 |
Last Update Date | 2007-07-08 |