NPI | 1922175181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 17415) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN 17415) |
122300000X Dentist (Licence: MI 2901017575) | |
Enumeration Date | 2006-11-30 |
Last Update Date | 2019-09-20 |