NPI | 1538206123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN18440) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME 3807) |
1223G0001X Dentist, General Practice (Licence: NH 3491) | |
1223G0001X Dentist, General Practice (Licence: FL DN18440) | |
Enumeration Date | 2007-01-31 |
Last Update Date | 2024-09-17 |