NPI | 1932504057 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL dn21032) |
Additional Taxonomies | 122300000X Dentist (Licence: NV 6576) |
Enumeration Date | 2014-10-31 |
Last Update Date | 2023-07-17 |