NPI | 1043745219 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26008) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DRPM1991) |
1223G0001X Dentist, General Practice (Licence: FL DRPM1991) | |
124Q00000X Dental Hygienist (Licence: FL DH24451) | |
Enumeration Date | 2017-04-26 |
Last Update Date | 2021-07-22 |