NPI | 1962797191 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CT 010493) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 03892) |
Enumeration Date | 2011-06-15 |
Last Update Date | 2016-09-19 |