NPI | 1710112800 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: NC 8754) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8754) |
Enumeration Date | 2009-05-19 |
Last Update Date | 2021-02-01 |