NPI | 1376814178 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 60555443) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020533) |
Enumeration Date | 2012-01-25 |
Last Update Date | 2019-07-29 |