NPI | 1225505704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN28140) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61513) |
Enumeration Date | 2018-11-01 |
Last Update Date | 2023-12-01 |