NPI | 1609227982 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS040880) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS040880) |
Enumeration Date | 2016-06-28 |
Last Update Date | 2022-07-21 |