NPI | 1114542602 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: LA 7056) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7056) |
Enumeration Date | 2020-06-10 |
Last Update Date | 2024-06-13 |