NPI | 1124468376 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 5988) |
Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-LIC-5988) |
Enumeration Date | 2013-07-02 |
Last Update Date | 2017-10-27 |