NPI | 1952592032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123752) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008863) |
Enumeration Date | 2007-08-05 |
Last Update Date | 2025-06-24 |