NPI | 1912292954 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26576) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DNCS000513) |
1223G0001X Dentist, General Practice (Licence: GA DNF000377) | |
Enumeration Date | 2011-06-17 |
Last Update Date | 2023-10-04 |