NPI | 1053030692 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 38972) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 38972) |
Enumeration Date | 2022-08-25 |
Last Update Date | 2024-05-13 |