NPI | 1801080015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2306) |
Additional Taxonomies | 122300000X Dentist (Licence: CO 9453) |
Enumeration Date | 2007-08-30 |
Last Update Date | 2011-08-11 |