NPI | 1841587425 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5735) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57908) |
Enumeration Date | 2011-07-05 |
Last Update Date | 2011-07-05 |