NPI | 1548751902 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 10085) |
Additional Taxonomies | 122300000X Dentist (Licence: KY 10085) |
Enumeration Date | 2018-05-22 |
Last Update Date | 2020-01-12 |