NPI | 1841555950 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NC 9289) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE 60281332) |
Enumeration Date | 2012-07-05 |
Last Update Date | 2016-03-03 |