NPI | 1801200134 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 3755-14) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AL 6099-C1) |
Enumeration Date | 2014-06-14 |
Last Update Date | 2015-02-26 |