NPI | 1902034119 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: UT 7362558-9922) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7362558-9922) |
Enumeration Date | 2009-06-25 |
Last Update Date | 2010-04-21 |