NPI | 1386166742 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60768332) |
Additional Taxonomies | 122300000X Dentist (Licence: OR D10668) |
Enumeration Date | 2017-07-07 |
Last Update Date | 2018-11-30 |