NPI | 1205121662 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11658) |
Additional Taxonomies | 122300000X Dentist (Licence: NE 6954) |
Enumeration Date | 2011-06-14 |
Last Update Date | 2024-05-13 |