NPI | 1053893123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2018020986) |
Additional Taxonomies | 122300000X Dentist (Licence: MO 2018020986) |
Enumeration Date | 2018-09-05 |
Last Update Date | 2024-08-19 |