NPI | 1487000998 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23625) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30025552) |
Enumeration Date | 2016-05-13 |
Last Update Date | 2018-11-13 |