NPI | 1578134193 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: GA DN122740) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 12337263-8903) |
122300000X Dentist (Licence: UT 12337263-9921) | |
1223G0001X Dentist, General Practice (Licence: UT 12337263-8903) | |
1223G0001X Dentist, General Practice (Licence: UT 12337263-9921) | |
Enumeration Date | 2021-07-06 |
Last Update Date | 2024-10-04 |