NPI | 1972582880 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00008876) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 12829) |
Enumeration Date | 2006-01-10 |
Last Update Date | 2015-04-27 |