NPI | 1013389295 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7137) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34787) |
1223G0001X Dentist, General Practice (Licence: DE G1-0001384) | |
1223G0001X Dentist, General Practice (Licence: NE 7268) | |
Enumeration Date | 2015-10-27 |
Last Update Date | 2024-01-08 |