NPI | 1003904400 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 12982) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN0012982) |
Enumeration Date | 2006-10-11 |
Last Update Date | 2018-08-14 |