NPI | 1487887972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE 60106594) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60106594) |
Enumeration Date | 2009-08-31 |
Last Update Date | 2018-04-19 |