NPI | 1972948560 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: VA 0401413549) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS041473) |
122300000X Dentist (Licence: CA 61885) | |
Enumeration Date | 2013-05-08 |
Last Update Date | 2022-07-21 |