NPI | 1326245671 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011216) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 43535) |
Enumeration Date | 2007-06-29 |
Last Update Date | 2022-03-22 |