NPI | 1972155018 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11073) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5048) |
Enumeration Date | 2019-07-09 |
Last Update Date | 2019-07-09 |