NPI | 1154524817 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5831) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 5831) |
Enumeration Date | 2007-06-08 |
Last Update Date | 2025-03-11 |