NPI | 1790929065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413836) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 25086) |
Enumeration Date | 2009-04-29 |
Last Update Date | 2022-11-29 |