NPI | 1841481702 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1000655) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60222405) |
Enumeration Date | 2007-08-06 |
Last Update Date | 2011-07-29 |