NPI | 1740253004 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: PA DS035599) |
Additional Taxonomies | 122300000X Dentist (Licence: DE G1-0001263) |
Enumeration Date | 2006-02-08 |
Last Update Date | 2010-05-11 |