NPI | 1831248079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL dn15255) |
Additional Taxonomies | 122300000X Dentist (Licence: KY 7545) |
122300000X Dentist (Licence: PR 3154) | |
Enumeration Date | 2007-01-09 |
Last Update Date | 2018-05-22 |