NPI | 1821310673 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D9523) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60174477) |
1223G0001X Dentist General Practice (Licence: MN D12663) | |
Enumeration Date | 2010-02-22 |
Last Update Date | 2011-02-23 |