NPI | 1689746232 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D05019) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 09846) |
Enumeration Date | 2006-11-15 |
Last Update Date | 2019-08-07 |