NPI | 1124258736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6902) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 29610) |
122300000X Dentist (Licence: CA 57861) | |
122300000X Dentist (Licence: FL DN18605) | |
Enumeration Date | 2009-07-16 |
Last Update Date | 2019-10-22 |