NPI | 1861521759 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 8253) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 150553) |
Enumeration Date | 2007-03-05 |
Last Update Date | 2007-07-18 |