NPI | 1073636221 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS030719L) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS030719L) |
Enumeration Date | 2007-04-10 |
Last Update Date | 2023-05-24 |