NPI | 1861592354 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 5277) |
Additional Taxonomies | 122300000X Dentist (Licence: KY 5277) |
Enumeration Date | 2006-09-24 |
Last Update Date | 2015-01-16 |