NPI | 1811145105 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10303) |
Additional Taxonomies | 122300000X Dentist (Licence: CO 10303) |
Enumeration Date | 2008-08-29 |
Last Update Date | 2015-06-02 |