NPI | 1851647697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: AL 5959) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA Dn014441) |
Enumeration Date | 2012-07-30 |
Last Update Date | 2016-07-07 |