NPI | 1871567016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE60192688) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30022014) |
122300000X Dentist (Licence: FL DN00000) | |
Enumeration Date | 2006-02-15 |
Last Update Date | 2015-11-12 |