NPI | 1245377639 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: FL DTP772) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN122650) |
1223G0001X Dentist, General Practice (Licence: NH 3354) | |
Enumeration Date | 2007-02-01 |
Last Update Date | 2023-11-29 |