NPI | 1962496851 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: OK 3175) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 3175) |
Enumeration Date | 2005-09-07 |
Last Update Date | 2018-05-24 |