NPI | 1881122091 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1626) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001534-15) |
Enumeration Date | 2017-06-01 |
Last Update Date | 2024-06-13 |