NPI | 1013975754 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 8058) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 11912) |
Enumeration Date | 2006-05-03 |
Last Update Date | 2020-10-13 |