NPI | 1053793893 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: AZ D009245) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D009245) |
Enumeration Date | 2015-06-28 |
Last Update Date | 2020-09-02 |