NPI | 1962598904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 4815) |
Additional Taxonomies | 122300000X Dentist (Licence: NC 4815) |
Enumeration Date | 2006-10-05 |
Last Update Date | 2008-01-14 |