NPI | 1194856955 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9694) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7174) |
1223G0001X Dentist, General Practice (Licence: WA DE00010805) | |
Enumeration Date | 2007-03-07 |
Last Update Date | 2020-06-18 |