NPI | 1073939997 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401-414350) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN015607) |
Enumeration Date | 2014-03-17 |
Last Update Date | 2020-09-03 |