NPI | 1245689728 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123428) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN 21873) |
Enumeration Date | 2016-06-06 |
Last Update Date | 2025-03-21 |