NPI | 1780840439 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9943) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2316) |
Enumeration Date | 2008-08-01 |
Last Update Date | 2013-06-07 |