NPI | 1528376266 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN24541) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NV 7187) |
1223P0700X Dentist, Prosthodontics (Licence: CA 60612) | |
Enumeration Date | 2010-09-15 |
Last Update Date | 2020-12-27 |