NPI | 1487702148 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25005) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00010693) |
Enumeration Date | 2007-01-08 |
Last Update Date | 2024-09-30 |