NPI | 1679585467 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DTP780) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901012237) |
122300000X Dentist (Licence: MI 29010012237) | |
Enumeration Date | 2006-08-12 |
Last Update Date | 2023-06-20 |