NPI | 1922154335 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60067325) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60067325) |
Enumeration Date | 2007-01-26 |
Last Update Date | 2023-12-27 |