NPI | 1114453529 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60737401) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60737401) |
Enumeration Date | 2017-05-04 |
Last Update Date | 2018-07-23 |