NPI | 1093976383 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2349) |
Additional Taxonomies | 122300000X Dentist (Licence: MN R418) |
Enumeration Date | 2008-06-19 |
Last Update Date | 2021-11-29 |