NPI | 1235224940 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 9916) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 51333) |
1223G0001X Dentist, General Practice (Licence: AZ d5892) | |
Enumeration Date | 2006-10-04 |
Last Update Date | 2023-08-29 |