NPI | 1154733087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10842) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15506) |
1223G0001X Dentist, General Practice (Licence: PA DS040270) | |
Enumeration Date | 2014-05-27 |
Last Update Date | 2021-11-16 |