NPI | 1104924521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN16965) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL D16965) |
Enumeration Date | 2006-09-20 |
Last Update Date | 2020-02-27 |