NPI | 1154557874 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2009013219) |
Additional Taxonomies | 122300000X Dentist (Licence: MO 2009013219) |
Enumeration Date | 2009-06-09 |
Last Update Date | 2022-08-01 |