NPI | 1093282972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE61250032) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN23802) |
Enumeration Date | 2018-10-29 |
Last Update Date | 2023-05-30 |