NPI | 1548222003 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D7571) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 5927) |
Enumeration Date | 2006-04-03 |
Last Update Date | 2025-07-17 |