NPI | 1952306813 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8021) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WY 1595) |
Enumeration Date | 2005-06-16 |
Last Update Date | 2021-10-26 |