NPI | 1609993781 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: FL 17376) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 4701) |
Enumeration Date | 2007-03-23 |
Last Update Date | 2019-01-31 |