NPI | 1104427418 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: GA DN122728) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 36786) |
Enumeration Date | 2020-11-03 |
Last Update Date | 2022-09-20 |