NPI | 1427026376 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2008035694) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD2639) |
Enumeration Date | 2006-03-08 |
Last Update Date | 2020-05-27 |