NPI | 1548327661 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28353) |
Additional Taxonomies | 122300000X Dentist (Licence: WA de00010680) |
Enumeration Date | 2007-01-02 |
Last Update Date | 2021-07-06 |