NPI | 1821389800 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1001662) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15870) |
1223G0001X Dentist, General Practice (Licence: VA 0401-412801) | |
1223G0001X Dentist, General Practice (Licence: PA DS-024916-L) | |
Enumeration Date | 2011-04-26 |
Last Update Date | 2020-02-19 |