NPI | 1699840959 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D11001) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 50868) |
Enumeration Date | 2006-11-22 |
Last Update Date | 2022-09-02 |