NPI | 1407931678 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA 232510054) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS025588L) |
1223G0001X Dentist, General Practice (Licence: PA DS025588L) | |
Enumeration Date | 2006-10-26 |
Last Update Date | 2021-03-10 |