NPI | 1073606380 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL D.6783-C) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30016143) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2021-03-09 |