NPI | 1891944856 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: UT 7411635-9921) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DR60024842) |
Enumeration Date | 2008-09-15 |
Last Update Date | 2016-09-01 |