NPI | 1881825032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9960) |
Additional Taxonomies | 122300000X Dentist (Licence: OR d9660) |
122300000X Dentist (Licence: AK DEN D 1310) | |
Enumeration Date | 2009-08-06 |
Last Update Date | 2024-07-31 |