NPI | 1699220863 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009991) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60682826) |
122300000X Dentist (Licence: AZ D009991) | |
122300000X Dentist (Licence: OR D10533) | |
Enumeration Date | 2016-08-17 |
Last Update Date | 2019-02-01 |