NPI | 1801128582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 9470) |
Additional Taxonomies | 122300000X Dentist (Licence: GA DN014026) |
Enumeration Date | 2010-02-05 |
Last Update Date | 2013-09-27 |