NPI | 1396086575 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008658) |
Additional Taxonomies | 122300000X Dentist (Licence: AZ D8658) |
Enumeration Date | 2013-03-12 |
Last Update Date | 2023-11-17 |