NPI | 1265420194 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE00011088) |
Additional Taxonomies | 122300000X Dentist (Licence: NM DD1803) |
Enumeration Date | 2005-10-13 |
Last Update Date | 2023-11-14 |