NPI | 1619263886 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE60127734) |
Additional Taxonomies | 122300000X Dentist (Licence: NV 5868) |
122300000X Dentist (Licence: HI DT 2433) | |
Enumeration Date | 2011-06-25 |
Last Update Date | 2021-02-05 |