NPI | 1053002329 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: AZ D011767) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: UT 13659941-9926) |
Enumeration Date | 2023-05-17 |
Last Update Date | 2024-02-15 |