NPI | 1760467476 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1241) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: KY 7680) |
Enumeration Date | 2005-12-14 |
Last Update Date | 2009-10-05 |