NPI | 1013402320 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416677) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DL13686) |
122300000X Dentist (Licence: MA DL14124) | |
Enumeration Date | 2018-06-28 |
Last Update Date | 2022-10-31 |