NPI | 1871560649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 9965) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 10375) |
Enumeration Date | 2006-03-01 |
Last Update Date | 2022-07-21 |