NPI | 1356623995 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 09501) |
Additional Taxonomies | 122300000X Dentist (Licence: NV 6109) |
122300000X Dentist (Licence: NE 6998) | |
Enumeration Date | 2011-09-09 |
Last Update Date | 2019-04-11 |