NPI | 1134147317 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN26256) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM 1608) |
Enumeration Date | 2006-07-17 |
Last Update Date | 2021-09-07 |