NPI | 1497065551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE60434325) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 7692415-9922) |
1223G0001X Dentist General Practice (Licence: OR D10029) | |
Enumeration Date | 2010-10-07 |
Last Update Date | 2019-02-04 |