NPI | 1730921032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE61221639) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE61221639) |
Enumeration Date | 2024-06-10 |
Last Update Date | 2024-06-10 |