NPI | 1487094116 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6703) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62473) |
Enumeration Date | 2013-06-26 |
Last Update Date | 2023-06-25 |