NPI | 1134673056 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN22149) |
Additional Taxonomies | 122300000X Dentist (Licence: FL 22149) |
Enumeration Date | 2016-08-09 |
Last Update Date | 2025-08-29 |