NPI | 1730184771 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA DE60267320) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60267320) |
122300000X Dentist (Licence: CA 45603) | |
1223P0700X Dentist, Prosthodontics (Licence: CA 45603) | |
Enumeration Date | 2005-06-16 |
Last Update Date | 2023-08-18 |