NPI | 1932217403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: WA DE00008184) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE00008184) |
Enumeration Date | 2006-08-26 |
Last Update Date | 2015-02-04 |