NPI | 1891860490 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: IA 8370) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 8370) |
Enumeration Date | 2006-11-21 |
Last Update Date | 2022-07-21 |