NPI | 1528022613 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 014868) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 6498) |
Enumeration Date | 2006-04-14 |
Last Update Date | 2025-08-05 |