NPI | 1932321130 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009597) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8308) |
Enumeration Date | 2007-05-03 |
Last Update Date | 2017-12-08 |