NPI | 1780766352 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 4019) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS017902L) |
Enumeration Date | 2006-10-20 |
Last Update Date | 2007-07-08 |