NPI | 1457701914 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DTP784) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DTP636) |
1223G0001X Dentist, General Practice (Licence: FL DTP636) | |
Enumeration Date | 2016-06-15 |
Last Update Date | 2023-06-21 |