NPI | 1932755691 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN26709) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60967757) |
Enumeration Date | 2019-08-16 |
Last Update Date | 2022-05-09 |