NPI | 1700182763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6545) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 60155) |
Enumeration Date | 2011-02-08 |
Last Update Date | 2023-03-07 |