NPI | 1669033189 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36000) |
Additional Taxonomies | 122300000X Dentist (Licence: OK 1356) |
Enumeration Date | 2019-06-25 |
Last Update Date | 2022-05-11 |