NPI | 1023592490 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61103820) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025406) |
Enumeration Date | 2018-09-20 |
Last Update Date | 2022-06-22 |