NPI | 1609322569 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA DN05164) |
Additional Taxonomies | 122300000X Dentist (Licence: GA DN05164) |
Enumeration Date | 2016-08-31 |
Last Update Date | 2023-06-28 |