NPI | 1780612820 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3063) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13508) |
Enumeration Date | 2006-06-29 |
Last Update Date | 2009-02-19 |