NPI | 1952586471 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN17893) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412008) |
122300000X Dentist (Licence: NC 150590) | |
Enumeration Date | 2008-01-03 |
Last Update Date | 2013-04-25 |