NPI | 1003823436 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: WI 5401) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5603-015) |
Enumeration Date | 2006-08-01 |
Last Update Date | 2020-09-25 |