NPI | 1649467184 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D9569) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 3417859922) |
Enumeration Date | 2007-09-28 |
Last Update Date | 2024-01-24 |