NPI | 1548798960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN24069) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 1668) |
Enumeration Date | 2017-05-30 |
Last Update Date | 2022-07-21 |