NPI | 1801983887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5870) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051893) |
Enumeration Date | 2006-10-09 |
Last Update Date | 2010-01-11 |