NPI | 1568916724 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NV 7627) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 100610) |
122300000X Dentist (Licence: AK 113885) | |
Enumeration Date | 2016-08-05 |
Last Update Date | 2023-06-02 |