NPI | 1750721387 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009088) |
Additional Taxonomies | 122300000X Dentist (Licence: AZ 9088) |
1223G0001X Dentist, General Practice (Licence: KS 61002) | |
Enumeration Date | 2013-06-27 |
Last Update Date | 2015-10-19 |